We describe a 66-year-old female who presented with recurrent acute pulmonary edema and uncontrolled hypertension. She was diagnosed with left renal artery stenosis and treated with angioplasty and stent placement. Her clinical status improved initially but symptoms recurred within 4 months. Further evaluation documented renal artery in-stent restenosis, which was successfully treated with cutting balloon angioplasty followed by brachytherapy. The feasibility of renal artery brachytherapy and short-term follow-up is presented.

Introduction Viral pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS COV-2) releases cytokines which result in neutrophils migration to the bloodstream and cytotoxic effect on lymphocytes. The ongoing pathology is reflected in the derangement of blood cells and the variations and calculations based on them that help in assessing the severity of the disease and prognosis. Aim This study aimed to compare the differences in the dynamic changes of the blood cells among survivors and non-survivors of COVID-19 disease so that cut-offs can be arrived at to aid triage at the intensive care unit (ICU) and to predict mortality. Material and methods A one-year study was conducted on patients hospitalized in the ICU. The demography and laboratory values of neutrophils and lymphocytes in percentages and absolute values, and platelet count in numbers were retrieved for eight consecutive values. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) was calculated from absolute counts. Statistical analysis was done using the Chi-Square test and Mann-Whitney test and a P-value of <0.05 is considered significant. The comparison was done between survivors and non-survivors. Result Among the 3142 patients admitted for COVID-19 disease, 7.6% required ICU care of whom 65.5% survived and 35.5% succumbed to the illness. Survivors were younger and comparable between both sexes. Though both groups had an ascending trend of neutrophils, lymphocytes, NLR, and PLR, the baseline characteristics were significantly lower in those who survived on a day-to-day basis. Neutrophilia above 80%, NLR 7.96, PLR 200 predicted the need for admission in ICU. Neutrophilia of 87% and lymphopenia of 10% were associated with adverse outcomes (mortality). Mortality can be predicted when neutrophil rises above 93% or lymphocytes fall below 5.2%. An initial NLR of 7.96 and PLR of 160 as well as peak NLR of 12.29 and peak PLR 400 predict mortality. Conclusion Serial blood counts are essential for hospitalized patients with COVID-19 for early triaging, and to assess severity and prognosis. The NLR of 6.7 and PLR of 160 require intensive care. The dynamic increase of NLR and PLR show worsening of the disease process and NLR of 40.95 and PLR of 400 predict mortality.

This study was carried out to detect beta (β) thalassemia heterozygous state in antenatal women and to create a validated flag in the software utilizing the screening indices to filter the samples to be subjected to high-performance liquid chromatography (HPLC) and to define a model for the prevention of thalassemia. MethodsThis cross-sectional study was carried out for a period of two years on women attending the antenatal clinic. Complete blood count (CBC) and peripheral smear were done during their first visit. Serum iron and total iron-binding capacity were done for women who had microcytic hypochromic anemia. The samples of women without iron deficiency were processed by HPLC for hemoglobinopathies. The spouses of women who were found to have beta thalassemia trait were counseled to undergo screening, and those who consented were tested. ResultsA total of 183 antenatal women were screened for hemoglobinopathies. Βeta thalassemia trait was detected in 23.5% of them. Among the 16 red blood cell (RBC) indices analyzed, Sehgal index and Mentzer index, both with sensitivities of 97.67%, were found to be suitable. Alert flag incorporated in the software of the analyzer to detect these indices helps not to miss samples to carry out HPLC. The spouses of women with β thalassemia trait who underwent HPLC testing were 55.81%. A model screening program was designed. ConclusionAntenatal testing by HPLC should be done on all mothers having microcytic hypochromic anemia without iron deficiency. Spouse testing of the woman who was carriers denotes the success of the antenatal screening program.